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MINIMALLY INVASIVE CARDIAC SURGERY (MICS) – A NOVEL WAY TO REACH YOUR HEART

Overview

Minimally invasive cardiac surgery (MICS) is an advanced form of the heart bypass procedure. The procedure involves making small cuts (keyhole incisions) in the chest to reach the heart, rather than cutting open the breastbone, as is done during open-heart surgery.

The surgeons perform heart surgery that is much less invasive compared to open-heart surgery using tiny instruments and robot-controlled tools.

A variety of heart conditions can be treated using the MICS procedure. This type of surgery, compared to open-heart surgery, means less pain and faster recovery for many individuals.

What is Minimally Invasive Cardiac Surgery (MICS)

MICS is a newer and advanced form of heart bypass surgery to treatment of coronary heart diseases. Through this technique, the heart is approached through the side of the left chest via a small 4 cm incision, often made using specialized surgical instruments. The heart is approached through openings between the ribs without cutting. This approach is less invasive compared with traditional open-heart surgery, in which surgeons open the chest to access the heart.

Types of MICS

There are three types of MICS. They include:

  • Minimally Invasive CABG Surgery: Unlike the CABG procedure where your chest is fully opened to perform surgery, MIDCABG or Minimally invasive direct Coronary Artery Bypass Graft surgery involves small cuts, generally made under the left breast area
  • Minimally Invasive Valve Surgery: Valve surgeries including valve repairs and valve replacements in the heart, are the most frequently used minimally invasive surgery
  • Beating Heart Bypass Surgery: Heart surgery performed while the heart is still beating

Potential Benefits of MICS

The potential benefits of MICS or Minimally Invasive Cardiac Surgery, when compared with open-heart surgery, may include:

  • No cutting of bones to open up the chest
  • Less pain
  • Decreased blood loss
  • Faster recovery
  • Lower risk of complications
  • Minimal scarring
  • Shorter hospital stay

Who can be benefited

Not all can be a candidate for Minimally Invasive Cardiac Surgery or Robotic Cardiac Surgery. Your heart specialist and the treatment team will work with you to determine if it is the right choice for you.

Your heart specialist may review your family history, conduct some physical examination and perform some tests to determine if you are candidate for MICS.

How to prepare for MICS

Before Robotic Cardiac Surgery or MICS, your heart specialist and the treatment team may explain to you about potential risks of the surgery and what to expect before, during and after the surgery. They will discuss the concerns you may have about your surgery.

You may have to shave the hair at the areas of the body where the procedure may take place. A special soap might also be used to wash your skin to reduce the risk of infection.

Before you get admitted to the hospital for the surgery, speak with your immediate family members about your hospital stay to discuss help you may need when you return home. Your heart specialist and treating team will provide you all the instructions to follow during your recovery after returning home.

What to Expect

During the MICS Procedure
Minimally invasive Cardiac Surgery may include thoracoscopic surgery, robot-assisted heart surgery and surgery through a small keyhole cuts in the chest (direct minimal invasive access heart surgery). In all types of less invasive procedures, the surgeons access your heart through small cuts between the ribs of the chest.

A tool attached with a small video camera is inserted through one of the keyhole cuts which will help the surgeon to see inside your body.

In most of the minimally invasive procedures a heart-lung bypass machine used, as is used in an open-heart surgery. The machine helps in blood moving through the body during the procedure.
Robotic Cardiac Surgery
In robotic cardiac surgery, the surgeon makes use of robotic arms, rather than his/her hands, to perform the surgery and does the exact maneuvers that is used in traditional open-heart surgery.

During robotic cardiac surgery, your surgeon works from a remote console and views your heart in a magnified, high-definition (HD), 3-Dimentional (3D) view on a video monitor. From the console, the hand movements of your surgeon translate precisely to the robotic arms present at the operating table, which moves similarly to our wrist.

A second heart surgeon and a surgical team assist at the operating table, changing the instruments attached to the robotic arms.
Thoracoscopic surgery
In this surgery (also called minithoracotomy), the surgeon inserts a thin, long tube (thoracoscope) having a tiny HD video camera into a keyhole incision in your chest. The surgeon repairs your heart using long instruments inserted through small keyhole incisions between your ribs.

After the MICS procedure

Usually, you will spend a day in the ICU (intensive care unit). fluids and medications will be administered through intravenous (IV) lines. Other tubes placed during surgery will help drain urine from the bladder as well as fluid and blood from the chest. You may be given oxygen through prongs in your nose or a facemask.

After the ICU, you may be moved to a regular hospital room for 3-4 days. Time spent in the ICU and the hospital will solely depend on your condition and the surgery.

The treatment team may:

  • Monitor your condition and lookout for signs of infection at the incision sites
  • Monitor breathing, blood pressure and heart rate
  • Help you manage pain
  • Help you get you and walk and provide instructions to enhance your activity gradually
  • Show you how to perform deep-breathing exercises and instruct you to cough to keep the lungs clear

Outcomes

After minimally invasive cardiac surgery, you may have reduced symptoms and improved quality of life. Your treating doctor will inform you when you can get back to daily activities, like driving, working and exercise.

You may have to attend regular follow-up appointments with your treating doctor. You may also undergo a few tests to evaluate and monitor your condition.

Your treating doctor may advise you to make healthy lifestyle changes, like a healthy diet, physical activity, avoiding tobacco use and stress management into your life. He or she may also recommend you to participate in a cardiac rehabilitation program, a program where education and exercise designed to help you recover after heart surgery and improve health.

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